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PTMMD > Wrist/Hand Pain with Radiating Pain > Flashcards

Wrist/Hand Pain with Radiating Pain Flashcards

1
Q

Pathoanatomy

What are other structures that pass through the Carple Tunnel other than the Median Nerve?

A
  • 4 tendons of FDS/FDP
  • Tendon of FPL

The Median nerve lies just beneth the flexor retinaculum/transverse carpal ligament

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2
Q

Clinical Practice Guideline for Carpal Tunnel Syndrome

What is the Cluster for Diagnosis for Carpal Tunnel Syndrome?

A
  • Age >45 years old
  • Shaking hands to relieve symptoms
  • Sensory loss on thumb
  • Boston Carpal Tunnel Questonnaire-symptom severity scale >1.9

3+ positive: sensitivity, 0.98 and specificity 0.54

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3
Q

Subjective History

What are reported findings for patients with Carpal Tunnel?

A
  • Numbness, tingling, pins and needles in the median nerve distribution
  • Symptoms ususally worse at night; May disturb sleep
    Pt. may be sleeping with the wrist in a position that may tension or compress the median nerve. which may lead to complaining of the pain that wakes them up
  • Difficulty picking up small objects
  • Symptoms aggravated by postures of wrist flexion and extension (stretch or compression of neurovascular bundle)
  • Hx of distal radius fracture

Majority of cases will present bilaterally

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4
Q

What are Occupational Risk Factors for Carpal Tunnel?

A
  • The use of vibratory tools
  • Repetitive movements of the hand/wrist
  • Intense computer use of at least 12 to 20 hours per week
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5
Q

What is commonly associated with Carpal Tunnel?

A
  • Diabetes
  • Obesity (BMI >25kg at least 2x risk)
  • Increasing age
  • Female Gender(1.5-4x more likely)
  • Pregnancy

DM and Obesity are comobilities

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6
Q

Specific Test and Measures for Carpal Tunnel

How may posture affect Carpal Tunnel?
What in the hand should we check (Think motor)?

A
  • Posture should be evaluated, and sustained postures should be considerd that may be adding stress to the median nerve.
    -This could mean sleeping positions or workstation environments
    -The pt should take a picture of themselves while they work so we can do an ergonomic assemssment.
    -Ask how the pt sleeps, they may need a brace at night to avoid excessive wrist flx/ext.
  • We must also check for Thenar Muscle atrophy; If there is significant muscle wasting, either the compression is really severe or its been going on for a long time. In these cases the pt needs more immediate decompression surgery
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7
Q

Specific Test and Measures for Carpal Tunnel

What may you find during the Joint Integrity examination?

A

This may reveal mobility limitations of the carpals of at the wrist joint

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8
Q

Specific Test and Measures for Carpal Tunnel

What may you find during A/PROM examination?

A

Wrist A/PROM may be altered or symptomatic at end-range wrist Flx/Ext.

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9
Q

Specific Test and Measures for Carpal Tunnel

What may you find during the strength assessment?

A
  • Weakness in muscles with motor innervation to median nerve
  • Weakness in grip strength
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10
Q

Specific Test and Measures for Carpal Tunnel

What may you find during the muscle length assessment?

A

May have altered length of wrist flexors and extensors

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11
Q

Specific Test and Measures for Carpal Tunnel

What will you find during the Neuro assessment?

A
  • Pain or paresthesia in median neve distribution
  • (+) ULNT 1
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12
Q

Specific Test and Measures for Carpal Tunnel

What special test would this patient most likely be positive for?

A
  • (+) Phalen’s
  • (+) Tinel’s on Carpal Tunnel
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13
Q

Specific Test and Measures for Carpal Tunnel

What should be done for the Movement Analysis for this patient?

A
  • Occupational related activities
  • Gripping
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14
Q

Specific Test and Measures for Carpal Tunnel

What are the Median Nerve Entrapment sites that should be palpated to rule in/out?

A
  • Bicep Aponeurosis
  • Ligament of Struthers
  • Pronator Teres
  • Carpal Tunnel
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15
Q

What are Associated Impairments with Carpal Tunnel?

A
  • Scapular Movement Faults
  • Periscapular Strength and scapulohumeral rhythm
  • Cervical or Thoracic Mobility Deficit (Espeically sensitivity at C5/C6 segments)
  • Deep Neck Flexor Assessment

Must also consider ergonomic and sleeping positions

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16
Q

What is the Prognosis for Carpal Tunnel?

A
  • Most tissues take about 6 weeks to heal (8-12 visits)
  • Healing time also depends on the health of the pt and the ability to avoid aggravating factors
  • Check for signs of atrophy, they are more likely a surgical canidate
17
Q

Interventions for Carpal Tunnel

What are Manual Therapy Interventions that can be done?

A
  • Myofascial release (MFR) /STM or manual stretch
  • Graded mobilization
18
Q

Interventions for Carpal Tunnel

What are Therapeutic Exercises that can be done with pts with carpal tunnel?

A
  • ROM
  • Postural training
  • Addressing associated impairments
  • Improving Neurodynamics
19
Q

Interventions for Carpal Tunnel

What are Motor Function Movement Training exercises that can be done with pts with Carpal tunnel?

A
  • Deep Neck Flx training
  • Scapular muscle training and/or mobility
20
Q

Interventions for Carpal Tunnel

What Functional Training can be done with pts with Carpal Tunnel?

A
  • Sleep training/positioning
  • Posture, ergonomics
21
Q

Interventions for Carpal Tunnel

What Modalities can be used with Carpal Tunnel?

A
  • Neutral/Cock-up wrist splint
  • Ultrasound
  • Lasar
22
Q

What type of Orthosis would be used for patients with Carpal Tunnel?

A

Wrist Controlled Orthosis (WHO)

23
Q

What is Ulnar Tunnel Syndrome?

A

This is entrapment of the Ulnar Nerve at Guyon’s Canal (around pisohamate ligament)

24
Q

If we suspect a patient has Ulnar Tunnel Syndrome, what should we ask them?

A

Whether they have any medical Hx involving diabetes and peripheral neuropathies

25
Q

What are Clinical Features of Ulnar Nerve impairment?

A
  • Claw hand resulting from unopposed action of the extensor digitorum communis in the fourth and fifth digits.
  • An inability to extend the second and distal phalanges of any of the fingers
  • Inability to Add/Abd the fingers or oppose all the fingertips, like making a circle with the thumb and forefinger
  • Inability to Add the thumb
  • At the wrist, FLX is weak and ulnar deviation is lost, Ulnar reflex is absent
  • Atrophy of the interosseous space (especially 1st) and the hypothenar eminence
  • Loss of sensation on the unlar side of ring finger and pinky
  • May have motor weakness or paralysis. Lesions that occur in the distal forearm or at the wrist space the deep flexors and the FCU
26
Q

What are surgical indications for those with Ulnar Tunnel Syndrome?

A
  • Preventing Deformity
  • Increasing functional use of the hand
27
Q

What are the Conservative interventions for Ulnar Tunnel Entrapment?

A
  • Applying a splint
  • Patient education to avoid positions and postures compressing the nerve

PTMMD (33 decks)

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